Incidence of Acute Kidney Injury After Computed Tomography Angiography±Computed Tomography Perfusion Followed by Thrombectomy in Patients With Stroke Using a Postprocedural Hydration Protocol

Abstract

Background The risk of contrast‐induced acute kidney injury (AKI) in patients with stroke receiving both computed tomography (CT) angiography and mechanical thrombectomy has been investigated only in small case series. No studies have investigated whether additional CT perfusion or chronic kidney disease (CKD) are associated with higher rates of AKI. Methods and Results Retrospective analysis of the AKI incidence in 1089 consecutive patients receiving CT angiography and mechanical thrombectomy from 2015 to 2017 and in subgroups with CKD (n=99) and CT perfusion (n=104) was performed. Patients received a standardized hydration protocol. Data on kidney function after mechanical thrombectomy were available in 1017 patients. A total of 59 (5.8%) patients developed AKI, and only 4 (6.8%) patients needed hemodialysis, all with known CKD. Patients with AKI significantly more often had known CKD (20.3% versus 8.4%, P =0.002), diabetes mellitus (33.9% versus 20.9%, P =0.018), and tandem occlusion (32.2% versus 16.2%, P =0.003) and a significantly higher in‐hospital mortality (20.3% versus 7.0%, P <0.001) compared with patients without AKI. However, there were no significant independent predictors for AKI in multivariable logistic regression analysis. Sex (odds ratio [OR], 2.03; 95% CI, 1.17–3.52 [ P =0.012]), higher National Institutes of Health Stroke Scale (OR, 1.10; 95% CI, 1.05–1.14 [ P <0.001]), AKI (OR, 3.52; 95% CI, 1.63–7.64 [ P =0.001]), diuretic use (OR, 1.80; 95% CI, 1.02–3.19), futile or incomplete recanalization (OR, 0.19; 95% CI, 0.09–0.40 [ P <0.001]), and total volume of contrast agent volume (OR, 1.007; 95% CI, 1.002–1.011 [ P =0.004]) were independently associated with in‐hospital death. Two thirds of the patients with AKI died of severe brain damage and not AKI itself. Conclusions Post‐contrast AKI rarely occurs in patients with stroke receiving a contrast agent for CT angiography/CT perfusion and subsequent mechanical thrombectomy. Patients with known CKD had higher rates of AKI and only these patients needed hemodialysis, but CKD was not independently associated with AKI or in‐hospital mortality.